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Enlarge/ This child, who had been ill with measles, exhibited the characteristic rash on the fourth day of its evolution. Measles can cause hearing loss and brain damage, and it can be fatal in young children.

Lawmakers in Oregon and Washington state are scrambling to pass new vaccination laws as a swiftly spreading measles outbreak rages in Washington’s Clark County, a hotbed of anti-vaccine sentiment just north of Portland, Oregon.

New bills aim to eliminate personal and philosophical exemptions for standard life-saving vaccines in schoolchildren—exemptions that have fueled such outbreaks and allowed once-bygone infectious diseases to come roaring back in the United States. But as the lawmakers work to craft their new bills, they may do well to keep a close eye on their counterparts in California, who are now realizing the pitfalls of such laws—and debating how to avoid them.

Since California banned non-medical vaccine waivers three years ago, the number of children with medical exemptions in the state has tripled. The medical exemption rate rose from 0.2 percent to 0.7 percent statewide. While California’s overall vaccination level increased two percent, there are still small pockets where vaccination rates are low. The boom in medical exemptions has left some counties’ vaccinations rates below the threshold necessary to keep diseases, such as measles, from spreading.

Researchers and health officials largely blame unscrupulous doctors for the problem. Some doctors have been found to loosely write exemptions for families trying to skirt vaccination requirements due to fear-mongering and misinformation spread from anti-vaccine advocates. Officials have even complained of doctors charging fees for handing out medical exemptions.

He is now working with medical organizations to come up with new legislation to crack down on the phony medical exemptions. “I think we need the health departments to basically say when someone is abusing [their] authority—and to withdraw that authority and invalidate exemptions that were fraudulent,” Pan said. Other ideas being discussed in the state include having state officials collect data on doctors who grant medical exemptions, as well as creating a review process for those exemptions, according to CALmatters.

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In Oregon, about one in five schools have vaccination rates below a protective 93 percent, and about 15,500 school children have non-medical exemptions, according to state records reported by The Oregonian. State Rep. Mitch Greenlick (D-Portland) is now working up legislation to wipe out the state’s personal vaccination exemptions.

“People have a right to make bad decisions about the healthcare of their children,” Greenlick told the paper. “But that does not give them the right to send unprotected children into their school.”

The planned bill will likely meet strong opposition. Similar legislation was struck down in 2015 amid protests from anti-vaccine advocates. Greenlick said he would not be deterred this time.

Likewise, Washington state Rep. Paul Harris, a Republican who represents Clark County, is now editing proposed legislation that would eliminate personal exemptions, leaving medical exemptions and tightly regulated religious exemptions, according to the Post.

“You cannot find a peanut in one of my schools [due to concerns over allergies], but unvaccinated kids are walking around in my schools because of a personal exemption?” Harris told the Post. “I find it appalling.”

In a public hearing Friday, Washington state's health secretary, John Wiesman, extolled the safety and efficacy of vaccines while debunking common anti-vaccine bunkum such as the noxious, long-discredited notion that vaccines cause autism. He urged lawmakers to scrap personal exemptions. “In states with tighter exemption laws, there is less suffering, fewer hospitalizations, and more deaths averted [from preventable diseases],” he said.

But, as in Oregon, the bill will hit firm opposition from vocal anti-vaccine advocates, who packed Friday’s hearing and murmured disapproval as Dr. Wiesman provided factual information about vaccine safety. One advocate told Post reporters that, if the legislation passes, vaccine opponents would “move out of the state or go underground, but they will not comply.” Another, Nicole Wilson, 32, who is pregnant and against vaccinations, said she, too, is considering moving if the bill passes.

“I’ll tell you something,” she added. “They are not going to change our minds.”

690 Reader Comments

I think we need to figure out just which doctors are providing all these medical exemptions. If the opioid crisis is any guide, there's likely a small number of bad actors in the medical community that originate a majority of the truly abusive exemptions.

One does need a medical license to practice, after all, and one can have their license stripped for ethics and practice violations.

“I’ll tell you something,” she added. “They are not going to change our minds.”

And they're really not.There is nothing you can do to change an anti-vaxxer's mind. When you get into an argument with one on forums or on Twitter or Ars, for that matter -- you are wasting your own time.

We just need to get them away from the rest of us -- I feel bad for their children, but unless you tear their children out of their hands and vaccinate them (which I'm all for, but will never happen in this country) then their children will not be vaccinated.

Move them out of the public sphere. Send them to the hills or the sewers.

One advocate told Post reporters that, if the legislation passes, vaccine opponents would “move out of the state or go underground, but they will not comply.” Another, Nicole Wilson, 32, who is pregnant and against vaccinations, said she, too, is considering moving if the bill passes.

Great, let's put you all in one area so to protect those that truly cannot get the vaccine.

Then I hope your children never get exposed to the disease because it'll be devastating for your community.

Sounds like there needs to be an audit process and/or a review board for medical exemptions.

Also, passing legislation cracking down on vaccine exemptions needs to be a nationwide initiative. Make it so if these terrible parents are willing to move to continue neglecting/abusing their kids' health they'll have to move to another country altogether to do it.

I think we need to figure out just which doctors are giving out all these medical exemptions. One does need a medical license to practice, and one can have their license stripped for ethics and practice violations.

Any doctor giving a higher-than-average number of exemptions should trigger immediate board review. If they fail to justify any exemptions under review, they should lose their license. Period.

Suffice to say, places where people have benefited from herd immunity for decades they're too farking stupid about history to understand the ramifications of their idiocy and thus latch onto things like the anti-vax movement because they haven't had a chance to see a child die of smallpox in front of them so it must not be that bad.

I think we need to figure out just which doctors are giving out all these medical exemptions. One does need a medical license to practice, and one can have their license stripped for ethics and practice violations.

Any doctor giving a higher-than-average number of exemptions should trigger immediate board review. If they fail to justify any exemptions under review, they should lose their license. Period.

Way past feeling charitable towards any of these ignoramuses.

I think exemptions need to be referred to a dedicated review board, as suggested above, but at minimum, I'd support this.

It's remarkable how much damage few wannabe celebrities managed to do!Between Jenny McCarthy and D̶r̶.̶ Wakefield, how many deaths and illnesses are they responsible for?And mass media, which published their "opinions" on front pages...

It would also help if there was more honest information on the side effects of vaccinations and frequency. It was annoying how it was downplayed.

Yes, your child might get a fever.Yes, you may have to stay home from work a day or two, and be woken by said toddler during the night.

That said, I do not like these "people" free riding on the pain my toddler went through, who has vaccinated. Each and every one of them (23 injections in the last 16 months).

Our pediatrician said exactly that - he might get a low grade fever, might be feeling under the weather for a day or two, keep an eye on it. It's a pretty standard disclaimer and I've gotten it every time I've ever gotten vaccinated for anything, near as I can recall.

There or may or not be ... but other countries do not have the level of Freedom of Religion that we have in the U.S. And as our LGBTQ friends are learning, Freedom of Religion has been getting stronger and stronger when compared to Public Policy.

if the legislation passes, vaccine opponents would “move out of the state or go underground, but they will not comply.”

Unfortunately it will be their kids who end up underground. There really needs to be very stiff penalties for parents who refuse to vaccinate their children. Legal penalties exist for not having your kids in seatbelts, not using car seats, and negligence, I feel vaccination should be treated the same way.

“I’ll tell you something,” she added. “They are not going to change our minds.”

"Never argue with an idiot, they'll only drag you down to their level and then beat you with experience"

Overall it seems we need to keep a closer eye on doctors writing these exemptions, I hope its only a very small number of bad actors writing these.

I think there needs to be a very strict and agreed upon set of guidelines were a medical exemption is warranted, and all exemptions should be audited annually by either a State Health Agency or some other proper board of experts. Doctors found to be giving unneeded exemptions should face harsh sanctions, with possibility of revoking their medical license or criminal charges if severe enough.

Insurance companies need to increase the premiums if a child is not vaccinated. That increase should also take in to account the increased claims due to loss of herd immunity. I'm sure they'll sing a different tune when they have to pay for their choices.

Every medical exemption has to be reviewed. Let's use red tape to weed out the fools who do not have a bona fide claim.

That would require a lot of bureaucratic resources and likely dip into some HIPPA type problems.

It'd be easier to simply have the office log the doctors order for each written exemption in a state database. That way the state health board could aggregate the names of the doctors who are writing the exemptions and figure out whose records to audit.

It would also allows schools to verify that an exemption is on file with the state health board. No more information beyond a valid response would be required from the system.